San Diego – In what is believed to be a first for a health system in the United States, Scripps Health is now offering genetic testing as part of its care for cardiovascular patients planning to undergo elective stent procedures.
The tests will determine if patients have one or more of the common gene variants linked to an inability to metabolize the anti-clotting drug Plavix (clopidrogel). Plavix is the second-most commonly prescribed drug in the United States and is given to most patients after they receive coronary stents.
The genetic test results will give doctors vastly improved data that will lead to an individualized approach to each patient’s treatment following a stent procedure. Stents are tiny metal tubes that cardiologists use to open clogged arteries.
Genetic testing for this population carries significant implications for patient care, as more than 1 million people undergo stent procedures in the U.S. every year. The gene variants associated with an inability to metabolize Plavix occur in more than 30 percent people of European ancestry and more than 40 percent of those of African or Asian ancestry. People with these gene variants carry double or triple the risk of death, heart attack or stroke, compared to people with the normal metabolism alleles in multiple large-scale studies.
“This represents a landmark program in individualized medicine, based on considerable new data and new choices for one of the most commonly prescribed medications and medical procedures in the world,” said Dr. Eric Topol, chief academic officer of Scripps Health. “This program demonstrates Scripps Health’s commitment to being at the forefront of individualized cardiovascular medicine.”
Scripps Health provides more cardiovascular care than any other provider in California. Last year, Scripps treated more than 45,000 cardiovascular patients. Scripps is currently designing the Scripps Cardiovascular Institute (SCI), which is planned to open in 2015.
“Knowing a patient’s individualized risk has a tremendous impact on treatment decisions,” said Dr. Paul Teirstein, head of interventional cardiology at Scripps Green Hospital and Scripps Clinic. “The point is to do everything we can to give patients the best possible outcomes. This kind of genomic screening gives us critical information we need to help patients.”
Scripps patients carrying the gene risk variants will be considered for three treatment choices following their stent procedures, each on an individualized basis. Patients will either:
- Be given a routine 75 milligram dose of Plavix with careful surveillance;
- Be given a 150 milligram dose of Plavix, which has recently been shown to be safe and effective in patients showing lack of response to Plavix; or
- Be given the newly approved medicine Effient (prasugrel), which is not affected by the gene variant Cytochrome (CYP) 2C19.
Scripps physicians will initially offer the genetic tests to elective stent patients before they undergo their procedures at Scripps Green Hospital. Eventually, Scripps may extend the offering to its other facilities across San Diego County.
Quest Diagnostics will perform the CYP2C19 testing for Scripps patients at its Quest Diagnostics Nichols Institute laboratory in San Juan Capistrano, Calif. The results will be transmitted to the treating physician and treatment choice will be tailored based on the patient’s risk for lack of Plavix effect, both with respect to the coronary anatomy and bleeding risk, since Effient (prasugrel) carries a significantly higher risk of bleeding than Plavix.
Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2 billion nonprofit community health system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,600 affiliated physicians and 12,700 employees among its five acute-care hospital campuses, home health care services, and an ambulatory care network of physician offices and 19 outpatient centers and clinics.
Recognized as a leader in the prevention, diagnosis, and treatment of disease, Scripps is also at the forefront of clinical research and graduate medical education.
Quest Diagnostics is the world’s leading provider of diagnostic testing, information and services that patients and doctors need to make better health care decisions. The company offers the broadest access to diagnostic testing services through its network of laboratories and patient service centers, and provides interpretive consultation through its extensive medical and scientific staff.
Quest Diagnostics is a pioneer in developing innovative diagnostic tests and advanced health care information technology solutions that help improve patient care.
Contact: Steve Carpowich